Offsite Borrow Affidavit

AML PROGRAM

OFFSITE BORROW AFFIDAVIT

STATE OF OHIO COUNTY: PROJECT: PROJECT NUMBER:

I, , being first duly sworn, deposes and says as follows:

1. That is the owner of certain real property located in Section(s) of Township, County, Ohio (see attached map) and being part of the lands described by Instrument recorded in Volume , Page of County, State of Ohio deed records.

2. That a certain borrow area located on this property can be used as a resoiling material for the reclamation of abandoned mined land.

3. That the Division of Mineral Resources Management (the "Division") desires to achieve reclamation of drastically disturbed lands in Ohio in order to eliminate environmental degradation of the lands and waters of the State and protect the public's health, safety, and general welfare.

4. That the Division desires to utilize this borrow area as a source of resoiling material for the Reclamation Project, Project Number , and that the quantity of resoiling material required to reclaim said project is estimated to be cubic yards.

5. That the Division, through a competitive bidding process, will hire a contractor to perform the reclamation work on said project.

6. That once all of the resoiling material has been acquired, the Contractor, hired by the Division, shall grade the affected area such that positive drainage is attained, lime, fertilize, seed and mulch all disturbed areas.

7. That in order to secure the reclamation project each potential contractor must submit a bid which lists a price per cubic yard the Contractor will be willing to pay for material required from this borrow area. The total number of cubic yards acquired by the Contractor shall be determined by a survey of the borrow area conducted before and after excavation. The survey shall be performed by a professional surveyor.

8. That each contractor will negotiate a price per cubic yard for the borrow material located on my property.

9. That by consenting to this affidavit I understand that the Division's contractor is not required to obtain any soil from my property. However, in the event that my property is used as a soil borrow area, all of the conditions of this affidavit shall be in effect.

10. Therefore, I promise to deal fairly with each contractor in negotiating a price for the borrow material located on my property and agree that by consenting to the use of my property as a source of resoiling material I waive my right to participate in the bidding or construction phase of said project in the capacity of either the Prime Contractor or Subcontractor.

Landowner:

Sworn to before me and subscribed in my presence this day of , 20 .

Notary Public

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